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Solicitation of donations from psychiatric patients has many complex bioethical ramifications. The most salient bioethical issues are those that have potential negative impact on the psychiatrist-patient relationship and are described below:
There is an implicit imbalance in all doctor-patient relationships including that of psychiatrists so that solicitation of donations may be exploitative.
Patients want to please their caregivers and may feel that even if the psychiatrist does not know who made the donation, these feelings may have a profound impact on the psychodynamics and transference.
A psychiatrist's letter soliciting a charitable donation from his or her own patients is a direct intrusion into the therapeutic process.
Voluntary faculty members who participate in the solicitation of such donations may be doing so to please their departments or department chairs with resultant impact on countertransference.
The importance of maintaining boundaries in all doctor-patient relationships cannot be emphasized enough.
The psychotherapeutic relationship is an extremely powerful one and is also an exquisitely delicate one. It is based on the trust and courage of individuals who are in need of help and deserve competent and compassionate care from their clinicians. It is unethical to use the profound influence of the psychiatric or psychoanalytic relationship to solicit contributions to anyone or anything. Solicitation of donations in the name of destigmatization of mental illness does not make them ethical.
A number of publications and organizations have carefully considered the issue of solicitation of donations by doctors from their patients and most take a clear stand against this process. The Ethics Committee of the APA (APA Ethics Committee, 2001) states that
“Solicitation of donations is an exploitation of the doctor-patient relationship …” The American Medical Association Opinion 10.018 states that physicians should avoid directly soliciting their own patients for d